Accessibility Services

Documentation That May Be Needed

Documentation for Requesting Accommodation(s)

In order to fully evaluate requests for accommodations or auxiliary aids at Lewis-Clark State College, additional information may be requested. All contact information and documentation received is kept confidential and will not be released without written consent. Documentation that may be requested includes, but is not limited to:

  • Diagnostic statement identifying the disability, date of the current diagnostic evaluation, and date of the original diagnosis
  • Description of the diagnostic criteria and/or diagnostic assessment used
  • Current functional impact of the disability
  • Treatments, medications, assistive devices/services currently prescribed or in use
  • Description of the expected progression or stability of the impact of the disability over time 
  • Credentials of any diagnosing professionals
  • Please note that a students high school I.E.P's are not considered official documentation, but can be used to help assign accommodations.
 Health Care1 If you need formal documentation, there are Community Assessment Providers that can assist you with acquiring the verification needed for accommodations.

 Disability Verification Forms

To ensure the provision of appropriate services for students, Accessibility Services may request that students provide current and comprehensive documentation of their disability and its impact on their education.

How to Complete the Forms: Forms can EITHER be printed and completed in paper form OR completed digitally.  IF FILLING OUT THE DIGITIAL FORM you need to download the form to be able to sign it, or you can print the completed form and sign the paper version.
Who completes the form? Forms are completed by the student's provider (doctor, etc) or evaluator.  Each form indicates the typical speciality who completes the form.

AdobeiconIf you want to sign the documents electronically, you may need to download Adobe Reader.  You can use Adobe Reader to fill and sign the documents.

FORMS:

Emotional Support Animal (ESA) Verification Form

Should be completed by a licensed physician, psychologist, or other licensed professional qualified to diagnose the specific disability of the student.

  • NOTE:
    • Therapy animals fall under the Human Resources Office
    • Service Animals are allowed at all campus locations per the ADA.  Under the ADA, a service animal is defined as an animal that has been individually trained to do work or perform tasks for an individual with a disability.  The task(s) performed by the animal must be directly related to the person's disability.

Mental Health Verification Form (Anxiety, Major Depressive, Bipolar, Impulse Control)

Should be completed by a licensed psychologist, neuro-psychologist, psychiatrist, or other licensed professional qualified to diagnose the specific disability of the student.

Neurocognitive Disorders Verification Form (Traumatic Brain Injury, PTSD)

Should be completed by a licensed psychologist, neuro-psychologist, psychiatrist, or other licensed professional qualified to diagnose the specific disability of the student.

Neurodevelopmental Disorders Verification Form (Autism, ADHD, Intellectual Disorder, Specific Learning Disorder)

Should be completed by a licensed psychologist, neuro-psychologist, psychiatrist, or other licensed professional qualified to diagnose the specific disability of the student.

Physical Sensory Disorders Verification Form (Audio, Visual or Auditory Processing)

Should be completed by a licensed physician, psychologist, audiologist, ophthalmologist, or other licensed professional qualified to diagnose the specific disability of the student.

Psychiatric and/or Psychotic Disorders Verification Form (Dissociative Disorder, Personality Disorders, Schitzophrenia or other Psychotic Disorders) 

Should be completed by a licensed psychologist, neuro-psychologist, psychiatrist, or other licensed professional qualified to diagnose the specific disability of the student.